Eosinophils Everywhere!

Resident report reviewed an ongoing case of a 37yo Guatemalan man who presented initially with 3 weeks of malaise, fatigue, subjective fevers and muscle aches found to have LLL infiltrate and small pleural effusion. He was sent home from the ER with a Z-pack. He represented to the ER 3 days later with no resolution of his symptoms, and was found at that point to have a WBC count of 11.5 with 23% eosinophils and a moderate L pleural effusion. A thoracentesis was pursued – 700cc of fluid was removed: 8000 polys with 75% eosinophils (pleural fluid eosinophilia a VERY wide differential diagnosis). This patient’s peripheral eosinophilia could be associated with bacterial infection, TB, parasites, acute HIV, or seronegative lupus. The patient had a rapid HIV Ab that was negative (VL pending), PPD placed (pending), stool O&P (pending), parasite serology (Strongyloides negative to date), pleural fluid cytology (pending), and negative ANA.

This afternoon the patient became hypoxic with respiratory alkalosis and delirium.  An LP was performed that showed 5% eos in the CSF – is this Churg-Strauss or hypereosinophilic syndrome without asthma symptoms?  Stay tuned for more information on patient outcome…

Light’s Criteria

Eosinophilia review

Parasites – when to order serology vs. stool O&P?